Oakland clinic a safety net for homeless youth

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Gabriel Elias, 6, opens wide for Doctor Kelley Meade during a check-up at the new clinic for homeless children on Saturday, September 22, 2007, which recently opened through Children's Hospital Oakland in Oakland, Calif. Elias, and his mother Susan Elias recently moved into an apartment in Oakland and are no longer homeless. (Susan Tripp Pollard/Contra Costa Times)

Nicole Lowe, 16, grimaces as licensed vocational nurse Danielle Baca punctures her skin as she draws blood from her hand for a test during a check-up at the new clinic for homeless children on Saturday, September 22, 2007, which recently opened by Children's Hospital Oakland in Oakland, Calif. Lowe lives with her baby Khadajah Lowe and mother Marlene Modkins at a downtown homeless shelter in Oakland. (Susan Tripp Pollard/Contra Costa Times)

Nicole Lowe, 16, cuddles with her baby Khadajah Lowe, seven months, after receiving a Nebulizer treatment for her Asthma during a check-up at the new clinic for homeless children on Saturday, September 22, 2007, which recently opened by Children's Hospital Oakland in Oakland, Calif. Lowe lives with her baby Khadajah Lowe and mother Marlene Modkins at a downtown homeless shelter in Oakland. Khadajah who was born premature is also seen at the clinic. (Susan Tripp Pollard/Contra Costa Times)

While waiting for her daughter to have a check-up, Marlene Modkins who grew up in Pittsburg plays with her granddaughter Khadajah Lowe, seven months, at the new clinic for homeless children on Saturday, September 22, 2007, which recently opened by Children's Hospital Oakland in Oakland, Calif. The three live at a homeless shelter in downtown Oakland and Khadajah, who was born premature also receives treatment at the clinic. (Susan Tripp Pollard/Contra Costa Times)

Case Manager LaTanya Knight visits with Gabriel Elias, 6, as he looks at his new inhaler with directions in many languages during a check-up at the new clinic for homeless children on Saturday, September 22, 2007, which recently opened by Children's Hospital Oakland in Oakland, Calif. Elias, was treated for his asthma and allergies and given a bike helmet during the appointment. (Susan Tripp Pollard/Contra Costa Times)

DR. KELLEY MEADE first tackles 6-year-old Gabriel Elias’ wheezing problem. Then she moves on to other questions: Does he get enough calcium in his diet?

“Yes, he loves milk,” says his mother, Susan Elias.

Has he lost weight unexpectedly? No.

Does he have a helmet for riding his bicycle? When Gabriel says no, Meade pulls out a tape measure and encircles his head, then brings him a new one to take home. Gabriel smiles, revealing a dimple.

This is not the stereotypical rushed doctor’s appointment. The blond-haired, blue-eyed boy is getting a thorough health check at a clinic that opened lastmonth for homeless children. Funded with a three-year, $1.5 million federal grant, the clinic is operated by Children’s Hospital Oakland.

It treats children who are living on the streets, in emergency shelters and in transitional housing. Many lack insurance.

“They’re very helpful — this is really great, especially for working moms or dads,” Elias said.

Many community clinics treat homeless children, but what makes this one unusual is that it is geared solely to such kids, with case managers who go out to find them.

It also is rare to have such a clinic owned and operated by a children’s hospital. The goal is to provide a permanent medical home and the kind of preventive care that keeps children out of emergency rooms.

“It’s a total delight to come here on Saturday and just see patients and know you’re doing medicine the way it should be,” Meade said.

About 1.35 million children are homeless in the United States each year, according to the National Law Center on Homelessness & Poverty.

Gabriel and his mother used to be homeless but since March have lived in a subsidized Oakland apartment.

Elias’ life began to spiral downward in 2003 after she was laid off from a low-level job in San Francisco. A landlord evicted her when she could not pay the rent.

She and Gabriel bounced from shelters to cheap hotels.

“He was still young enough to not know what was going on,” she said. “I’m really thankful about that.”

Homelessness poses severe challenges for anyone, but it can be particularly tough on children.

Hotel rooms often lack kitchens, making it difficult to provide good nutrition.

“We ate a lot of cereal and sandwiches,” Elias said. “It is hard to keep a kid healthy.”

Shelters have limited food choices because of tight budgets.

“Children don’t necessarily get wonderful, five-food-group meals with good protein and fresh fruits and vegetables,” said Cheryl Zlotnick, who oversees the clinic. “We see a lot of oral health issues as a result. For older children, obesity is an issue.”

One of the hotels Elias stayed in had a flea problem. But when she used a flea spray it aggravated Gabriel’s asthma.

Infectious diseases are common health issues because of so many people living in tight quarters.

Elias has begun to turn her life around thanks in part to a full-time job as a produce manager at a small San Francisco grocery store.

But the job had an unintended consequence common to the working poor: It provided health insurance for her, but not for Gabriel. Worse yet, it boosted her income to where she makes slightly too much for Gabriel to qualify for Medi-Cal, a government-run health program for low-income people.

Gabriel had been uninsured until Elias learned recently that he will be approved for Healthy Families, another government-sponsored program.

“Before I got him into Healthy Families, every day I was praying nothing would happen to him,” she said.

Those who oversee the clinic have discovered they must do things differently because of the population they serve.

They have breakfast foods available, for example, and bread and peanut butter for sandwiches.

The clinic is open 10 a.m. to 2 p.m. Saturdays in a Claremont Avenue building, where Children’s Hospital Oakland operates a primary care clinic during the week.

Because many shelters serve food only at specific times, getting to an appointment might mean missing a meal.

“Do you eat or do you make sure the child has medical care? What an awful dilemma,” Zlotnick said.

“We make sure we have breakfast foods in the clinic. They’ll have yogurts and cheese and bread and snacks.”

Children receive a goodie bag when they leave that includes a toothbrush, toothpaste, juice and snacks.

Gabriel also walked out with an inhaler and spacer for his asthma, a book he selected to take home about trains and a bike helmet. Clinic doctors have learned not to assume that patients can get needed medication or obtain transportation to another appointment.

If they are living in a shelter, they also may not be able to eliminate dust, get rid of rugs or make other changes to ease a child’s asthma symptoms.

Nicole Lowe, 16, arrived at the clinic one recent Saturday morning with her 7-month-old baby, Khadajah, and her mother, Marlene Modkins. They came by bus.

Khadajah was born premature and weighed less than 3 pounds. Alta Bates Summit Medical Center transferred her to Children’s Hospital Oakland, where she stayed for six weeks.

Nicole and her mother, who were both living in a car at the time, made frequent trips to the hospital to visit the baby. Shortly before the hospital released Khadajah, Nicole and her mother obtained a spot at the Henry Robinson transitional shelter in downtown Oakland. They now have a small room with a kitchenette while they search for permanent housing.

“The shelter was like a God-send because if we hadn’t found a place to stay, they wouldn’t let us bring her home,” Modkins said.

Nicole is a ninth-grader at Envision Academy of Arts and Technology in Oakland. She was treated at the clinic for asthma, allergies, a boil on her leg and tendinitis in one arm. Dr. Dayna Long told her the tendinitis may be from carrying her baby.

Long gave her prescriptions for an inhaler, allergy medicine and other medications. Because Nicole has no insurance, the clinic qualified her for Gateway, a program that provides temporary insurance while her Medi-Cal application is processed.

To assist families with the numerous needs and stresses they face, the clinic employs two case manager/outreach workers. LaTanya Knight, a case manager with a winning way with children, hits the streets to bring people to the clinic.

Armed with fliers, she visits soup kitchens, food banks, churches, shelters and anywhere else that a homeless parent and child may be found.

“What’s different about this program is that we go out to find families, rather than wait for them to come to us,” Zlotnick said.

The case manager/outreach workers also help parents obtain resources, such as finding a preschool or making a dental appointment.

The goal is to have children be seen at least three times at the clinic. Those who want to continue to receive care through Children’s Hospital Oakland will be assigned a primary care provider and have the hospital’s other medical services and programs available to them.

“We can really provide the full breadth of care that families need,” Zlotnick said.

The clinic hopes to serve 500 children this year. Many of them will qualify for Medi-Cal.

“They’re fast and professional and very, very nice,” Modkins said. “I’m just glad this was here because I didn’t know what we were going to do.”

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